Cross-sectional survey examining skin picking and hair pulling disorders during the COVID-19 pandemic

In silicodevelopment and validation of Bayesian methods for optimizing deep brain stimulation to enhance cognitive control

Objective.deep brain stimulation (DBS) of the ventral internal capsule/striatum (VCVS) is a potentially effective treatment for several mental health disorders when conventional therapeutics fail. Its effectiveness, however, depends on correct programming to engage VCVS sub-circuits. VCVS programming is currently an iterative, time-consuming process, with weeks between setting changes and reliance on noisy, subjective self-reports. An objective measure of circuit engagement might allow individual settings to be tested in seconds to minutes, reducing the time to response and increasing patient and clinician confidence in the chosen settings. Here, we present an approach to measuring and optimizing that circuit engagement.Approach.we leverage prior results showing that effective VCVS DBS engages cognitive control circuitry and improves performance on the multi-source interference task, that this engagement depends primarily on which contact(s) are activated, and that circuit engagement can be tracked through a state space modeling framework. We develop a simulation framework based on those empirical results, then combine this framework with an adaptive optimizer to simulate a principled exploration of electrode contacts and identify the contacts that maximally improve cognitive control. We explore multiple optimization options (algorithms, number of inputs, speed of stimulation parameter changes) and compare them on problems of varying difficulty.Main results.we show that an upper confidence bound algorithm outperforms other optimizers, with roughly 80% probability of convergence to a global optimum when used in a majority-vote ensemble.Significance.we show that the optimization can converge even with lag between stimulation and effect, and that a complete optimization can be done in a clinically feasible timespan (a few hours). Further, the approach requires no specialized recording or imaging hardware, and thus could be a scalable path to expand the use of DBS in psychiatric and other non-motor applications.

The Effect of Covid-19 on the Hair Diseases Observed in Health Care Providers: Analysis of 513 Participants

INTRODUCTION

The Covid-19 pandemic has been shown to have major acute and chronic impacts on the skin. Various studies reported that there has been an increase in the number of patients referred to outpatient dermatology clinics with the complaint of variable hair diseases during the era of Covid-19. Hair seems to be substantially affected by both the infection itself and anxiety/stress provoked by the pandemic. Therefore, understanding the impact of Covid-19 on the clinical course of variable hair diseases has become a major concern in dermatology practice.

OBJECTIVES

To examine the frequency and types of various hair diseases, both new-onset and ingravescent, observed in healthcare providers.

METHODS

A web-based questionnaire related to the hair diseases seen in healthcare providers both prior to the Covid-19 pandemic and after the start of the pandemic was created. The type of both new-onset and pre-existing hair diseases and ongoing hair diseases observed during Covid-19 were investigated.

RESULTS

A total number of 513 participants were included in the study. One hundred seventy cases were diagnosed with Covid-19. During the Covid-19 pandemic, 228 reported having at least one hair disease; the most common one being telogen effluvium, followed by hair greying and seborrheic dermatitis. There was a statistically significant relationship between the presence of a new-onset hair disease during the pandemic and being diagnosed with Covid-19 (p=0.004).

CONCLUSION

Our study shows that Covid-19 infection has a significant impact on the emergence of new-onset hair diseases.

Extended follow-up of a comprehensive behavioral (ComB) treatment sample during the COVID-19 pandemic

This study provides the longest follow-up yet for comprehensive behavioral (ComB) treatment of trichotillomania (TTM) (M = 24.59 months after pre-treatment and 15.92 months after the last follow-up point in a recent clinical trial (Carlson et al., 2021), which had shown ComB to be significantly more efficacious than minimal attention at post-treatment). This study also examined changes in TTM severity from before to during the COVID-19 pandemic. Participants (N = 23) completed a survey assessing current TTM symptoms, the impact of the pandemic on their coping with TTM, and their experience with ComB treatment. Self-reported symptom severity at this follow-up evaluation fell between the scores obtained at the clinical trial's pre-treatment assessment and at its last follow-up before the pandemic and did not significantly differ from either time point. Most participants (73%) reported some change in their TTM management since onset of the pandemic, with changes to their environment/routine (61%) and in anxiety (32%) being the most common. Pandemic-related changes were associated with variable outcomes, improving symptoms and management for some while worsening them for others. Use of strategies from ComB had declined since the most recent follow-up, but more than half (55%) of participants reported that strategies from ComB remained useful.

Trichotillomania and excoriation disorder: Primary care implications

ABSTRACT

Trichotillomania and excoriation disorder are two psychiatric conditions that have similar origins to obsessive compulsive disorder. Both can cause patients significant distress and lead to medical consequences. It is important that primary care NPs identify and refer these individuals for psychiatric treatment.